Provider Demographics
NPI:1265468599
Name:SNYDER, RODNEY W
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:W
Last Name:SNYDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1439
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98071-1439
Mailing Address - Country:US
Mailing Address - Phone:253-333-0299
Mailing Address - Fax:
Practice Address - Street 1:202 N DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-4939
Practice Address - Country:US
Practice Address - Phone:206-920-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740461425OtherGROUP NPI
WA1314202Medicaid
WA1740461425OtherGROUP NPI
WAA05673Medicare UPIN
WA1314202Medicaid